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ATTACHMENT B City of Mounds view <br /> 2401 Highway 10 <br /> Mounds View,MN 55112-1499 <br /> (612) 784-3055 <br /> CHILDREN'S SERVICE WORKER BACKGROUND CHECK <br /> Because the position for which you are applying will require you to provide care, treatment, education, training, <br /> instruction, or recreation to children, the City of Mounds View will perform a background check under Minnesota <br /> Statutes Chapter 299C.62, Section 2,through the Criminal Justice Information System(CJIS). The information that <br /> you provide will be used to determine your eligibility for becoming or continuing as a City employee or volunteer <br /> who provides care, treatment, etc. to children. You are not legally required to provide the requested information; <br /> however, refusal to provide the requested information will disqualify you from the position for which you are <br /> applying. The information that you provide will be made available to the Bureau of Criminal Apprehension and to <br /> authorized City representatives who have a need to know the information. Under state law, the information you <br /> provide may become public if ordered by a court of law. <br /> Have you ever been convicted of any of the following crimes? <br /> ( ) YES ( )NO <br /> If yes, please attach a description of the crime and the particulars of the conviction. <br /> BACKGROUND CHECK CRIMES <br /> Under Minnesota Statutes Ch. 299C. <br /> Murder <br /> Manslaughter <br /> Felony Level Assault <br /> Any Assault Crime Committed Against A Minor <br /> Kidnapping <br /> Criminal Sexual Conduct <br /> Prostitution-Related Crimes <br /> Arson <br /> or any of the following Child Abuse Crimes committed against a minor victim constituting a violation of Minnesota <br /> Statute Sections: <br /> 609.185, (5) Murder in the 1st degree, <br /> 609.221 Assault in the 1st degree, <br /> 609.222 Assault in the 2nd degree, <br /> 609.223 Assault in the 3rd degree, <br /> 609.224 Assault in the 5th degree, <br /> 609.2242 Domestic assault, <br /> 609.322 Solicitation, inducement, and promotion of prostitution, <br /> 609.323 Receiving profit derived from prostitution, <br /> 609.324 Other prohibited acts, <br /> fl <br /> 609.342 <br /> 609.343 <br /> 609.344 <br /> Criminal sexual conduct in the 1st degree, <br /> Criminal sexual conduct in the 2nd degree, <br /> Criminal sexual conduct in the 3rd degree, <br /> 609.345 Criminal sexual conduct in the 4th degree, <br /> 609.352 Solicitation of children to engage in sexual conduct, <br />